Healthcare Provider Details

I. General information

NPI: 1215304639
Provider Name (Legal Business Name): COUNSELING SERVICES OF ANDERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 PEARMAN DAIRY RD STE E
ANDERSON SC
29625-1315
US

IV. Provider business mailing address

1944 PEARMAN DAIRY RD STE E
ANDERSON SC
29625-1315
US

V. Phone/Fax

Practice location:
  • Phone: 864-402-9991
  • Fax:
Mailing address:
  • Phone: 864-402-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5318
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4606
License Number StateSC

VIII. Authorized Official

Name: AMY KILPATRICK
Title or Position: LPC/OWNER
Credential:
Phone: 864-402-9991